Last week, the Kaiser Family Foundation released its February tracking poll. The results? Three quarters of respondents had a “very favorable” (40%) or “somewhat favorable” (34%) opinion of Medicaid. Over half of respondents (52%) said that the Medicaid program is working well for most low-income Americans covered by the program.

On Monday, someone who has a very unfavorable opinion of Medicaid and believes it is not working well – CMS Administrator Seema Verma – underscored her antipathy:  

“And as I’ve talked to people that are on the Medicaid program, folks don’t want to be there, they want a better life.  And it’s easy to just hand people a health insurance card but it’s a much harder task to help them make the changes to move out of the Medicaid program and hopefully to a better life, to a new job that provides health insurance.”

The job description of the CMS Administrator is to direct the implementation of the Medicaid program, not to trash it. So why would the CMS Administrator send a message to the 68 million Americans enrolled in Medicaid that if they left the program they would have a “better life,” with the clear implication that if they don’t want to give up their Medicaid coverage, they don’t want a “better life”?

Here’s one possibility: she wants to gut Medicaid’s popular support. If the public continues to hold a favorable view of the Medicaid program — and to enroll in the program if they are low-income and need health coverage — it will be much harder for the Administration to persuade the Congress to cap federal payments to states – which, as my colleague Joan Alker noted, is “the holy grail.”

The Administrator’s effort to reverse the results of the Kaiser tracking poll is not confined to trash talking. She is also trying to reframe Medicaid the “health insurance program” into Medicaid the “welfare program.” To this end, she has been granting and actively promoting “demonstrations” that enable states to condition Medicaid coverage on documenting work. She has already approved 3 – Kentucky, Indiana, and now Arkansas – and says that 8 states have waiver applications “in the hopper” and that 9 more states have “expressed interest in moving forward.”  

The federal courts have been asked to determine whether the Administrator has the legal authority to radically restructure Medicaid under the guise of “demonstrations.” There is little doubt that the rapid approval of multiple “demonstrations” all testing the same “hypothesis” is a litigation tactic, an effort to make the “demonstrations” too big to fail. But however the courts ultimately rule, the Administrator appears to be doing all she can to undercut support for the health insurance program she is charged with implementing.
There is also little doubt there will be collateral damage in the form of coverage losses. Will the low-income Americans who now have health insurance through Medicaid but lose it due to paperwork requirements be on their way to a “better life”? Or will they join the ranks of the uninsured, with higher risk of preventable illness and bankruptcy? And why would any CMS Administrator want to test that question?